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Categories Uncategorized, Advice, Food, Gut Health, Health, Nutrition, Protein

Confused about collagen?

Author Amber Hudler Posted on

Collagen supplements are becoming increasingly popular. Are you confused by them? You may be wondering whether or not this is something your body needs, or if these types of supplements even work. This post will help you decide if it’s right for you.

Understanding collagen

Collagen is a protein made up of amino acids. It is one of the most prevalent proteins found throughout the body. It is present in bones, skin, tendons, ligaments, cartilage, your intestinal lining, and other fibrous tissues.  The main role of collagen is to provide structural support to your tissues. There are different forms of collagen, but the primary amino acids that comprise it are glycine, proline, and hydroxyproline.

Role of collagen

As we age, collagen levels decrease. This can lead to issues such as osteoarthritis, joint pain, stiff tendons, wrinkled skin, and GI disturbances. As a result, collagen is being added to beauty products and dietary supplements as a means of providing anti-aging benefits, reducing joint pain, supporting healthy bones and healing leaky gut.

Benefits of collagen

While some studies are mixed, there is strong evidence to support the following benefits of collagen

  • Promotes skin elasticity, hydration, anti-aging and improvement in overall appearance.
  • Can increase bone density and reduce bone loss
  • Helps reduce joint pain and stiffness
  • Can increase the process of wound healing

There is moderate evidence to support these additional benefits*

  • May support growth of hair and nails
  • May increase muscle mass
  • May protect against mucosal damage and support a healthy intestinal barrier
  • May support cardiovascular health

*Further studies are needed

Collagen food sources

So how can you obtain collagen naturally? Collagen is mainly found in animal tissue – primarily in the joints, tendons and bones. Bone broth is another common food source. You can purchase commercially made bone broth, but the best way to reap the benefits is to make it yourself. Here is a recipe you can try.

If eating animal carcass or drinking bone broth is not your thing, you can also try consuming foods that synthesize collagen and support its production. These include poultry, game meat, organ meat, fish, shellfish, cheese, egg whites, seeds, spirulina, and soy.

Collagen supplements

Collagen supplements come in a variety of forms including capsules, gummies, powders. One of the most common and versatile forms of collagen supplements can be found in bovine, chicken, or marine collagen peptides.

Collagen peptides are the result of larger collagen molecules being broken down into short chain amino acids. Peptides are ideal because they break down easily in liquids. You can add them to both cold and hot beverages, such as coffee or a smoothie. You can also include them in baked goods.

There is no recommended dietary allowance (RDA) for collagen, but on average 2.5-1.5g per day have been utilized in studies. As with all supplements, I only recommend professional grade brands. Supplements are not regulated so quality really does matter. For example, with some commercial protein powders, there is concern about potential lead contamination. It’s worth investing a few more dollars to know that what you are consuming is safe. As always, before consuming any supplement I urge you to talk with a qualified healthcare practitioner to determine if you really need it.

For more tips like these or to book a session, contact me here

Sources:

  • The Functional Nutrition Library
  • https://health.clevelandclinic.org/
  • https://www.todaysdietitian.com/newarchives/0319p26.shtml
  • https://www.ncbi.nlm.nih.gov/pubmed/23375414
  • https://www.ncbi.nlm.nih.gov/pubmed/25884286
Categories Food, Health, Nutrition, Weight Loss

Understanding Macros Part 3: Fats

Author Amber Hudler Posted on

So you’ve learned about carbs and proteins, now it’s time to focus on fats. One of the most important things that fats can do is provide us with fullness and satiety. Plus they taste great! Read on to learn about the right types of healthy fats to include in your diet.

FATS

Historically, fats in the diet have been blamed as a leading cause of heart disease and weight gain. Current science has taught us that this simply is not true. Fats play a critical role in keeping us healthy. You read that correctly – fats keep us healthy. And by including the right type of fats in your diet, you will not only improve your heart health, you may even lose a few pounds while you are at it.

Fats refer to a type of nutrient known as lipids. Lipids include three main groups: triglycerides, phospholipids, and sterols. Triglycerides are by far the most common type of fat both in our diet and in the body. A key characteristic of lipids is that they are insoluble in water. Fats and oils are two main types of lipids. Fats are lipids that are solid at room temperature. Oils are lipids that are liquid at room temperature.

Fats play a key role in the body. Some of the key functions of fats include:

  • Cushioning joints
  • Protecting bones, body organs and nerves from injury
  • Digestion and absorption of fat-soluble vitamins
  • Slowing gastric emptying and supporting digestion
  • Providing satiety at meals
  • Supplying us with energy
  • Preserving body heat and providing insulation to help us stay warm

In our diet, fats can fall into three broad categories: Trans fats, saturated fats, and unsaturated fats.

Most trans fats do not occur naturally in nature. The majority were created by the food industry to promote the shelf life of products. Trans fats work by adding hydrogen to vegetable oil, which causes the oil to become solid at room temperature. Trans fats are by far the worst type of fat you can consume. They are most commonly found in foods such as stick margarine, vegetable shortening, processed foods such as store bought cookies, snack cakes, potato chips, and fried foods at fast-food restaurants. Research has shown that trans fats are a leading cause of elevated cholesterol and heart disease. They raise triglycerides and LDL, lower HDL, increase inflammation and promote insulin resistance.

Saturated fats have been under debate for quite some time. While at one point saturated fats were also thought to be a contributor to heart disease, more current research has shown that the right types of saturated fats can actually be cardio-protective. Saturated fats are found in foods such as butter, coconut oil, marbled red meat, lard, ghee, full fat dairy, fried foods, dessert foods. Obviously, you want to avoid the last two. But the saturated fast found in foods like grass fed butter and coconut oil are the right types of saturated fats. Why? There is some evidence to support that certain types of saturated fats can actually increase the particle size of LDL, making it less harmful then LDL particles that are small and dense. Also, when fats are grass fed (such as butter and red meat) you are also getting a source of Omega-3 fatty acids which can help to raise HDL, your good cholesterol.

Speaking of Omega-3’s, unsaturated fats include polyunsaturated, monounsaturated, and Omega-3 fatty acids. These can be found in foods such as a fatty fish like salmon and tuna, nuts, seeds, flax, chia, avocados, avocado oil, olives, and olive oil. These are the BEST types of fats to choose. They raise HDL, lower inflammation, play a key role in maintaining healthy vision, reduce risk of cognitive decline, and support a healthy pregnancy.

Why does it matter?

The right type of fats are not only health promoting, but they are also satiating. Like protein, fats in the diet digest slower, keeping you fuller longer. Fats will not impact your blood sugar, so by including them you will be able to keep your blood sugar balanced, sustain your energy levels, curb cravings, and overall consume less food.

Key takeaway

Not all fats are bad! Strive to incorporate mostly unsaturated fats in your diet. I typically recommend about 85-90% of your fats should come from unsaturated sources. Use high quality saturated fats about 10-15% of the time. Choose ones like grass fed beef, grass fed butter, ghee, or coconut oil. These types of saturated fats have a better nutritional profile and in the case of grass fed products, contain omega-3 fatty acids. Fats take a longer time to digest, so they provide fullness and satiety. Many unsaturated fats are found to be heart protective.

Summary

If you finish a meal and still feel hungry, you may not be getting enough healthy fat. Fats provide us with satiety, meaning that we will feel fuller and more satisfied then if we exclude them from our diet. Knowing how to properly balance your fats in order to meet your needs will set you on the right path to achieving your goals.

If you’ve made it this far, I’m proud of you! It is my hope that these posts have provided you with some clarity around the right types of macros to eat and WHY.

Want to know your specific macronutrient needs? Contact me here for a nutrition counseling session.

Sources:

Mahan, K.L., & Escott-Stump, S. (2008). Krause’s food and nutrition therapy. St. LouisMissouri: Saunders Elsevier.

Murray, M. T., & Pizzorno, J. (2012). The Encyclopedia of Natural Medicine, 3rd Edition. New York, New York: Atria paperback.

Rolfes, S. R., Pinna, K., & Whitney, E. (2009). Understanding normal and clinical nutrition, eighth edition.   Belmont, California: Wadsworth, Cengage Learning.

https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/trans-fat/art-20046114

https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/fat/art-20045550

Categories Food, Health, Nutrition, Weight Loss

Understanding Macros Part 2: Protein

Author Amber Hudler Posted on

Hopefully you read about carbs in part one of this series. If not, you can check it out here. In part two of understanding macros, the focus is on protein. Protein performs many functions in the body and is essential to maintaining a healthy weight. Most of my clients are not getting enough. Read on to learn about the importance of protein and the minimal amount you should be aiming for in your diet.

PROTEIN

Proteins are mainly comprised of 20 different building blocks known as amino acids that are linked together in long chains by amino bonds. Amino acids are comprised of three types: essential, non-essential, and conditionally essential. Essential amino acids cannot be produced in the body and must be provided through food. The nine essential amino acids are:

Histidine

LysineThreonine

Isoleucine

Methionine

Tryptophan

LeucinePhenylalanine

Valine

 

A complete protein is one that contains all nine essential amino acids. All animal proteins are complete proteins. An incomplete protein is lacking one or more essential amino acids. Most plant based proteins are incomplete proteins. Sometimes, certain combinations of incomplete proteins can make them a complete protein. Examples of these combinations include rice and beans, edamame and walnuts, or oatmeal with almonds.

Non-essential amino acids can be provided by food, however the body can also produce these on its own. Conditionally essential amino acids are normally non-essential, but they are supplied by the diet when the need for them exceeds the body’s ability to produce it.

Amino acids are required to enable protein to perform its many functions, which include:

  • Growth and maintenance of skin, tendons, membranes, muscles, organs, and bones
  • Repair of body tissues
  • Hormone regulation
  • Digestion support in the form of enzymes
  • Fluid Balance
  • Acid-base regulation
  • Transportation of nutrients including vitamins, minerals, oxygen and lipids
  • Formation of antibodies to fight infection
  • An additional form of energy and glucose

Foods that contain protein include meat, poultry, fish, eggs, beans, lentils, soy, nuts, nut butters, seeds, and certain grains. When choosing meat such as beef, pork, lamb or eggs, be selective. Look for products without antibiotics and where applicable, choose pastured / grass fed. Remember that whatever the animal consumed, we consume. Choose lean cuts so that you can eat an ample portion.

A serving size of protein is generally 3-4 ounces for women, slightly more for men, or about the size of the palm of your hand. At a minimum, individuals should consume 0.8-1.0 grams of protein per kg of body weight per day. This is a general recommendation and can vary based upon an individual’s needs, goals and healthy history. For weight loss, I generally recommend a higher amount. It is important to know that while protein is beneficial for many reasons, consuming too much protein can be detrimental. For this reason, I don’t always recommend certain types of protein supplements that exceed safe amounts.

Why does it matter?

Protein performs many valuable functions within our body. In addition to helping us build muscle and fight off infections, protein works synergistically with carbs to extend the energy that carbs provide. About 3-4 hours worth. Protein also provides satiety. Simply put, incorporating protein at meals will keep you fuller longer and help to offset blood sugar crashes that occur when our diet is too high in carbohydrates. I recommend including protein at each meal and snack, and especially at breakfast. By starting your day with protein, you will avoid those early morning blood sugar spikes that often lead to fatigue, mood changes, brain fog, and cravings.

Key takeaway

Protein can be essential in helping us to balance our plate and maintain a healthy weight. When choosing protein, choose a variety of high quality sources. Be aware of which combinations of plant based foods provide you with a complete protein. Include protein at each meal and snack, and combine it with a complex carb to provide energy longer.

Summary

Balancing carbs with protein will help utilize the energy they provide, but also extend it throughout the day to help keep you balanced. Adequate protein in the diet will also help to build muscle, keep your hormones balance, and support digestion.

Want to know your specific protein needs? Contact me here for a nutrition counseling session.

Sources:

Mahan, K.L., & Escott-Stump, S. (2008). Krause’s food and nutrition therapy. St. LouisMissouri: Saunders Elsevier.

Murray, M. T., & Pizzorno, J. (2012). The Encyclopedia of Natural Medicine, 3rd Edition. New York, New York: Atria paperback.

Rolfes, S. R., Pinna, K., & Whitney, E. (2009). Understanding normal and clinical nutrition, eighth edition.   Belmont, California: Wadsworth, Cengage Learning.

Photo by Alex Munsell on Unsplash

Categories Food, Health, Nutrition, Weight Loss

Understanding Macros Part 1: Carbohydrates

Author Amber Hudler Posted on

Macronutrients (commonly referred to as macros) are carbohydrates, proteins and fats. We know that healthy eating and proper nutrition is more than just counting calories. It’s about eating whole, real foods that are minimally processed and packed with nutrients. But to lower your risk of disease and to maintain a healthy weight, it is also important to understand the types of macronutrients your calories consist of and to maintain the right balance 😉 of each.

So let me explain a little bit about macros and why they should matter to you. In Part 1 of this 3-part blog, we’ll begin with arguably the most debated type of macronutrient: Carbohydrates.

CARBOHYDRATES

Carbohydrates have several functions. They provide our bodies with fuel and energy, they support our brain and they support our nervous system. Whether it’s to perform our day-to-day activities, exercise, or to simply focus better at work or school, carbs are an essential part of the diet.

Energy from carbohydrates is provided to our cells in the form of glucose (also known as blood sugar). When we eat any form of carbohydrate, our blood sugar rises. The carbohydrates are then broken down into glucose molecules, which are transported into our cells by our fat storage hormone insulin. Once our cells are at capacity for glucose absorption, any remaining glucose in the blood is moved to our muscles or our liver where it is stored in the form of glycogen. Once glycogen stores are at capacity, excess glucose is converted to fat. When our body needs energy, our fat burning hormone glucagon brings glucose out of storage and back into the blood for use by all the other cells. It is important to note that these two hormones cannot operate at the same time. So, we are either in fat burning mode or fat storage mode throughout the day.

Carbs are comprised of two types: Simple carbs and complex carbs. Simple carbs are sugars comprised of molecules known as monosaccharides and disaccharides. Complex carbs are comprised of fibers and starches.

Monosaccharides are a single molecule of sugar. They are the easiest type of carbohydrate to be absorbed in the body, and can cause our blood sugar to rise the fastest. Monosaccharides include glucose, fructose, and galactose and occur naturally in fruit, honey, and dairy. Other sources include processed foods and beverages which contain high fructose corn syrup such as soda, cakes, cookies, pastries, certain breads, and ready to eat cereals.

Disaccharides are pairs of monosaccharides. They include maltose (glucose + glucose), sucrose (glucose + fructose) and lactose (glucose + galactose). Sucrose is commonly known as table sugar, and dairy products contain lactose. Disaccharides are digested less rapidly then monosaccharides because during the digestion process, the two molecules must be broken apart to be absorbed. However, disaccharides still cause our blood sugar to elevate more quickly then the final group of carbohydrates, which is complex carbs.

Complex carbs are comprised of long chains of monosaccharides, known as polysaccharides. All plant foods (fruits, vegetables, beans, legumes, and whole grains) contain forms of complex carbohydrates. Complex carbs take a longer time to break down in the body and to move through our digestive tract. They cause our blood sugar to rise the slowest. This helps to keep us fuller longer, and more effectively balance blood sugar by avoiding rapid spikes and dips that can commonly occur.

Foods that contain complex carbs include starches and fibers. Starches are found in plant based foods such as grains (rice, wheat, millet, rye, barley, and oats), beans, legumes, potatoes, yams, cassava, breads and pasta. Fiber (an indigestible carbohydrate) includes two types: soluble and insoluble. Soluble fiber is known to protect against heart disease and diabetes due to its ability to lower cholesterol and blood sugar. This is imperative for individuals who are trying to manage high cholesterol, pre-diabetes or diabetes. Foods that contain soluble fiber include oats, barley, legumes, and citrus fruits. Insoluble fiber is also valuable in the diet because it bulks the stool to promote regular bowel movements and alleviate constipation. It can also help to feed our gut bacteria and support a healthy microbiome. Foods that contain insoluble fiber include celery, corn, and bran. Strive for a minimum of 20-30g of fiber per day. Include both soluble and insoluble fiber sources in your diet.

A serving size of most carbs is about a half a cup or the size of your fist. In terms of how many carbs you need in a day, this can vary per individual based on your calorie needs, health conditions, and your goals.

Why does it matter?

To function at its best, our body must be provided with enough glucose to support our energy needs, but not too much to cause harm. Our cells can only absorb so much glucose at a time. As mentioned earlier, excessive amounts of glucose (from eating too many carbs or too high a volume of simple carbs) will cause glucose to get stored in the form of fat. This can lead to chronically elevated blood sugar which can cause fatigue, cravings, difficulty focusing, elevated cholesterol, weight gain, pre-diabetes, and diabetes. In contrast, low blood sugar which can result from either a sudden blood sugar ‘crash’ after eating a high carb meal, or by consuming a diet too low in carbs, can lead to issues such as dizziness, light headedness, sweating, weakness, anxiety, confusion, and hunger.

Key takeaway

Not all carbs are bad. Aim to consume mostly complex carbohydrates in your diet. Complex carbs provide you with fiber. They are more slowly digested which will keep you fuller longer, provide you with more energy by preventing blood sugar spikes, and keep you at the lowest risk of disease. Remember that fruit and veggies can count as your carbs.

Summary

If you are struggling with energy levels and find it difficult to get through your day let alone your workouts you may not be eating enough carbohydrates. Carbs provide us with energy, so we need them in our diet. Diets that exclude carbs will only work for a short period of time, but eventually they will not be able to meet your daily energy needs and sustain you throughout your day.  The problem with carbs is that most of the time, we tend to get the wrong ones (simple carbs) and at too large of a portion. Strive for complex carbs in order to keep you fuller longer, and combine them with protein to help balance blood sugar and extend your energy levels. To learn more about protein, stay tuned for Part 2 of this post.

Want to know more about your specific carbohydrate needs? Contact me here for a nutrition counseling session.

Sources:

Mahan, K.L., & Escott-Stump, S. (2008). Krause’s food and nutrition therapy. St. LouisMissouri: Saunders Elsevier.

Murray, M. T., & Pizzorno, J. (2012). The Encyclopedia of Natural Medicine, 3rd Edition. New York, New York: Atria paperback.

Rolfes, S. R., Pinna, K., & Whitney, E. (2009). Understanding normal and clinical nutrition, eighth edition.   Belmont, California: Wadsworth, Cengage Learning.

Photo by Monika Grabkowska on Unsplash

Categories Gut Health, Nutrition, Stress

A Nutritional Approach to GERD

Author Amber Hudler Posted on

The incidence of Gastroesophageal Reflux Disease (GERD) has dramatically increased over the last few decades. I know I see a lot of it in my practice. This blog post will help you to understand the most common causes of reflux, dietary factors that contribute to symptoms, and some helpful tips for management and prevention.

 

GERD is most often caused by the flow of gastric juices (stomach acid) up the esophagus, which can result in a burning sensation, pain, or discomfort often referred to as heartburn. The condition typically intensifies following a meal and when lying down. While some individuals may suffer from occasional cases of heartburn that are easily resolved with over the counter medications such as antacids, GERD is more of a chronic condition. GERD can place individuals at a higher risk for swallowing difficulties, esophageal inflammation, ulcers, and certain cancers.

GERD is frequently associated with abnormalities or a decrease in pressure of the lower esophageal sphincter (LES). Your LES is a valve that controls the flow of food from your esophagus into your stomach. Normally this valve should close tightly, keeping hydrochloric acid and gastric juices in their rightful place – your stomach – so that they can help you digest your food properly. When the LES is compromised, the valve does not close fully, or it opens too often, and stomach acid will creep up into the esophagus as foods are being digested.

GERD can also be associated with muscle contractions known as gut motility. In a healthy gut, foods are normally pushed through the GI tract from the esophagus into the stomach, from the stomach into the small intestine, and from the small intestine into the colon. However, when the gut is impaired, these contractions can become compromised and cause a disruption in the digestive process.

Another factor to consider is hypochlorhydria or low stomach acid. While it may sound counterintuitive, having too little stomach acid can disrupt natural digestion, causing food to remain in the stomach longer then it should. This can cause major discomfort for many individuals including reflux-like symptoms.

Consuming foods that weaken the LES (see list below), along with increased stress, anxiety, and gut dysfunction, can make the symptoms associated with GERD occur more frequently and at a higher intensity.

 Common causes of GERD include:

Overeating / Obesity (puts pressure on the stomach)

Smoking (relaxes the LES)

Ingestion of the following trigger foods (weakens the LES):

  • Alcohol
  • Soda / Carbonated beverages
  • Coffee / Caffeine
  • Chocolate
  • Fatty / Greasy / Fried foods
  • Spicy foods
  • Acidic foods (tomatoes, orange juice, citrus fruit)
  • Peppermint / spearmint
  • Onions / garlic
  • Sugar

Stress (impairs gut motility)

Use of certain medications (NSAIDS, calcium channel blockers, Bisphosphonates)

Additional considerations include:

  • Bacterial overgrowth such as H. pylori, SIBO or yeast
  • Celiac Disease
  • Hiatal Hernia (stomach pushes up through the diaphragm muscle)
  • Food sensitivities / Allergies
  • Chronic constipation
  • Micronutrient deficiencies (from use of GERD medications) such as zinc, B12

When reviewing this list, you may find that few or many of these items pertain to you. The list of trigger foods is a general one, and not all foods listed will trigger symptoms in all individuals with reflux. But it is important to know which ones exacerbate your particular symptoms and to avoid those whenever possible. This will allow your esophagus to heal and will help to avoid the pain and discomfort associated with this condition.

Conventional treatment and management of GERD often involves:

  • Weight loss (when appropriate)
  • Continual avoidance of trigger foods
  • Eating smaller meals
  • Raising the head of the bed
  • Use of certain medications such as antacids and acid-blocker drugs such as Proton Pump Inhibitors (PPIs)
  • Avoidance of eating within 2-3 hours of lying down or going to bed
  • Avoidance of tight clothing that can put pressure on the LES
  • Avoidance of certain exercises that can put pressure on the LES such as sit-ups, inverted yoga poses, and certain forms of heavy lifting

Additional recommendations that can help include:

  • Slowing down at meals
  • Sitting at meals (avoid standing)
  • Taking smaller bites
  • Chewing food thoroughly. This can actually increase saliva production which can help support the integrity of the esophageal mucosal barrier, which is often impaired in reflux patients.
  • Consume meals that are lower in fat
  • Consume meals that are lower in carbohydrates (to help maintain a healthy weight)
  • Consume fermented foods (to support a healthy microbiome)
  • Avoid consuming large amounts of fluids with meals
  • Begin a routine of gargling at night to stimulate the vagus nerve (supports healthy digestion)
  • Stress reduction / Lifestyle change
  • Regular exercise

There are several types of supplements that can support GERD naturally and can help avoid the harmful side effects of PPIs. These include:

  • Deglycyrrhizinated licorice(DGL)
  • Limonene (extracted from citrus fruit peel)
  • Zinc Carnosine
  • Magnesium Citrate or Glycinate
  • Aloe Vera
  • Slippery Elm
  • Marshmallow
  • Glutamine (to heal)
  • Probiotics (to balance the microbiome)
  • Digestive Enzymes
  • Ginger
  • Iberogast (for motility)

It is always important to work with a qualified healthcare practitioner to receive a proper diagnosis for reflux and to identify the root cause.

In addition, many people find it valuable to work with a dietitian to help control their diet, which will make it easier to manage reflux and its related symptoms.

Common dietary approaches that I recommend in practice:

  • Identify and avoid trigger foods
  • Avoid processed foods and those high in refined sugar that can impair gut integrity and motility
  • Identify and support any nutrient deficiencies
  • Practice the key principles of eating properly (slow down, chew your foods, do not overeat)
  • Dietary support of Hypochlorhydria if present
  • Dietary support of bacterial infections if present
  • Incorporation of fermented foods and probiotics to heal the gut and support your microbiome
  • Stress reduction each day

 

Sources:

Gaby, Alan R., MD. Nutritional Medicine. Alan R. Gaby, M.D., 01/2011. VitalBook file.

Murray, M. T., & Pizzorno, J. (2012). The Encyclopedia of Natural Medicine, 3rd Edition. New York, New York: Atria paperback.

University of Wisconsin School of Medicine and Public Health. An Integrative Approach to GERD (Gastroesophageal Reflux Disease). (2018)

Mullin, G. E., & Swift, K. M. (2011). The Inside Tract: Your good gut guide to great digestive health. New York, New York: Rodale.

https://www.iffgd.org/motility-disorders.html

Rishikof, D. Health Takes Guts Ebook, 2018.

Hyman, M. 7 Steps to Reduce Acid Reflux. 2018.

https://www.mayoclinic.org/diseases-conditions/gerd/expert-answers/heartburn-gerd/faq-20058535